Heart Valve Repair Device

ABSTRACT

A heart valve annulus repair device having a tissue engaging member and a plurality of anchors. The tissue engaging member includes a loop of wire. Each of the anchors has a pointy front end and a back end and a slot that runs in a front-to-back direction. The anchors are distributed about the loop of wire with the front ends of the plurality of anchors facing the heart valve annulus and with the loop of wire passing through the slots. The device further includes means for implanting the anchors into the heart valve annulus tissue so that the tissue engaging member becomes affixed to the heart valve annulus.

FIELD OF THE INVENTION

The present invention relates to medical devices, in particular, devicesfor repairing biological valves.

BACKGROUND OF THE INVENTION

The mitral valve is positioned in the heart left side, between the leftatrium and the left ventricle. The most typical disease of the mitralvalve is insufficiency or regurgitation which occurs when the valveleaflets do not coapt properly. Mitral valve repair by suturing a ringto reduce the annulus diameter is the procedure of choice to correctmitral regurgitation. With the use of current surgical techniques, mostregurgitant mitral valves can be repaired or replaced with artificialvalve prosthesis.

Currently, mitral valve repair requires an extremely invasive surgicalapproach that includes a sternotomy, cardio-pulmonary bypass, cardiacarrest, and an incision in the heart itself to expose the mitral valve.Such procedure is associated with high morbidity and mortality. Apercutaneous device that can effectively treat the disease without theneed for open heart surgery could greatly improve patient benefit andmay include other patients that currently cannot be treated with surgerybeing too old or frail for such invasive procedure.

Most current surgical practices for mitral valve repair involve mitralvalve annuloplasty and/or mitral valve valvuloplasty.

Surgical annuloplasty is a technique aimed to reduce the size of thefibrous tissue at the base of the mitral valve, called the annulus.Sometimes the annulus becomes enlarged, enabling blood to back flow upinto the left atrium, through the gap between the two separated valveleaflets. The repair is done with sutures to make the opening smaller,helping the two leaflets meet and co-apt again when the valve closes.

Surgical valvuloplasty is a technique aimed to ensure proper closure ofthe valve leaflets. Leaflet function can be impaired as the result ofprolapse of a leaflet due to ruptured chordae. The leafletreconstruction is done by leaflet resection and reshaped with sutures.In most cases both annuloplasty and valvuloplasty is needed in order toregain optimal mitral valve function.

Due to the invasive nature of the mitral valve surgery, and the highrisks involved in the procedure, many heart failure patients are poorsurgical candidates. Thus, less invasive methods and devices to reducemitral valve regurgitation would make this therapy available to manymore patients.

US2004/102839, US2004/1022840, U.S. Pat. No. 6,656,221, U.S. Pat. No.6,718,985, U.S. Pat. No. 6,723,038 and US2004/073302 describe minimalinvasive approaches to mitral valve annuloplasty, using percutaneousinsertion of device into the left ventricle or into the coronary sinus,in order to decrease the annulus size.

U.S. Pat. No. 6,626,930 and U.S. Pat. No. 6,575,971 disclose a deviceand method of fastening two pieces of the valve leaflets together,improving competence of the valve.

US2004/243227, US2007/244554, US2008/262609, and US2009/0287304 describepercutaneous devices which attach to the valve annulus via anchoringmechanisms and contract, thereby reducing annulus diameter in a singlestep.

US2007/016286 discloses a transluminal collapsible heart valve designedto attach to the native annulus of the native regurgitating mitral valveand replace all in a single step. US2012/010700 provides a method forimplanting a prosthetic valve apparatus that includes a one way valveand an expandable valve seating. The apparatus is anchored and securedin a newly created orifice near or at the center of the anterior valveleaflet.

Today it is possible to replace an aortic valve (the valve positionedbetween the left ventricle and aorta) with no surgery through newlydeveloped percutaneous procedures. In these procedures an artificialcollapsed valve is delivered through the arteries and positioned insidethe diseased native valve, and then expanded to replace it. To datethere is yet no acceptable analogous procedure that can do the same forthe mitral or tricuspid valves.

Following the success of percutaneous replacement of the aortic valve,many attempts have been made to develop similar devices intended forpercutaneous treatment of the mitral valve but due to the fact that thisvalve annulus is much bigger and amorphously shaped, and there are nolumen walls or calcific leaflets that may function as retaining surfaceslike in the aortic valve, make it very difficult to prevent dislodgmentof a valve expanded into place in the mitral position. Attaching a valveto the mitral annulus with anchoring features is very challenging for apercutaneous procedure and has not been very successful yet.

Devices that are attached to the mitral annulus and then collapsed toreduce its diameter need to be secured very tightly and accurately tothe tissue in order to withhold the high forces that are required toreduce the annulus diameter.

Compared to the aortic valve percutaneous procedures, all the devicesand procedures mentioned above have not been successful for the mitralvalve yet.

SUMMARY OF THE INVENTION

The present invention relates to a device, method and kit for helpingrepair a biological valve and is particularly suited for repair ofmitral, tricuspid and such valves, though not necessarily limited tosuch implementations.

In accordance with embodiments of one aspect of the invention there isprovided an apparatus for performing a procedure on a heart valveannulus, the heart valve annulus having an original shape, the apparatuscomprising: a tissue engaging member including a loop of wire configuredto conform with at least a portion of the original shape when the loopof wire is deployed, and a plurality of anchors, each of the pluralityof anchors having a pointy front end and a back end, each of theplurality of anchors having a slot that runs in a front-to-backdirection, wherein the front ends of the plurality of anchors areconfigured for implantation into heart valve annulus tissue in a forwarddirection and wherein the plurality of anchors are configured so thatsubsequent to implantation, the plurality of anchors resist extractionfrom the heart valve annulus tissue in a backwards direction, whereinthe plurality of anchors are arranged with respect to the loop of wireso that when the loop of wire is deployed the plurality of anchors aredistributed about the loop of wire with the front ends of the pluralityof anchors facing the heart valve annulus and with the loop of wirepassing through the slots in the plurality of anchors. The apparatusfurther includes means for implanting the plurality of anchors into theheart valve annulus tissue so that the tissue engaging member becomesaffixed to the heart valve annulus.

In some embodiments, the loop of wire comprises a closed loop. In someembodiments, the at least a portion of the original shape comprises atleast a 270° portion of the original shape. In some embodiments, each ofthe plurality of anchors includes a barb that, subsequent toimplantation, resists extraction from the heart valve annulus tissue ina backwards direction. In some embodiments, each of the plurality ofanchors the back end of the slot is enlarged to form an eyelet. In someembodiments, in each of the plurality of anchors the slot begins nearthe front end of the anchor and ends near the back end of the anchor,and wherein, during implantation, forward motion of the plurality ofanchors is limited when the ends of the slots encounter the loop ofwire.

In some embodiments, the tissue engaging member further includes aplurality of tubes threaded onto the loop of wire between the pluralityof anchors, wherein an outer surface of the tubes comprises a materialthat promotes tissue growth. In some embodiments, the tissue engagingmember further includes a second loop of wire that is threaded throughthe inside the plurality of tubes, and wherein the second loop of wirecomprises a closed loop.

In some embodiments, at least a portion of the second loop of wire issurrounded by a material that inhibits tissue growth. In someembodiments, the plurality of anchors comprises at least six anchors.

In some embodiments, the means for implanting comprises a plurality ofcompressed springs configured to, respectively, implant the plurality ofanchors into the heart valve annulus tissue so that the tissue engagingmember becomes affixed to the heart valve annulus. In some embodiments,the means for implanting comprises a plurality of pull wires configuredto, respectively, implant the plurality of anchors into the heart valveannulus tissue so that the tissue engaging member becomes affixed to theheart valve annulus.

In some embodiments, the loop of wire comprises a closed loop, whereineach of the plurality of anchors includes a barb that, subsequent toimplantation, resists extraction from the heart valve annulus tissue ina backwards direction, and wherein the plurality of anchors comprises atleast six anchors. In some embodiments, the means for implantingcomprises a plurality of compressed springs configured to, respectively,implant the plurality of anchors into the heart valve annulus tissue sothat the tissue engaging member becomes affixed to the heart valveannulus. In some embodiments, the means for implanting comprises aplurality of pull wires configured to, respectively, implant theplurality of anchors into the heart valve annulus tissue so that thetissue engaging member becomes affixed to the heart valve annulus.

In some embodiments, the apparatus further comprises a catheter having adistal end; and a scaffold comprising a plurality of support armsconfigured to support the plurality of anchors in position adjacent tothe heart valve annulus in a position at which the means for implantingcan implant the plurality of anchors into the heart valve annulustissue.

In some embodiments, the heart valve annulus is a mitral valve annulus,and the apparatus further comprises: a catheter having a distal end; anda scaffold comprising a plurality of support arms, wherein the scaffoldis configured for deployment when the distal end of the catheter ispositioned in the left atrium and the scaffold is further configured tosupport the plurality of anchors in position adjacent to the uppersurface of the mitral valve annulus in a position at which the means forimplanting can implant the plurality of anchors into the mitral valveannulus, wherein the catheter is configured to push the plurality ofanchors towards the upper surface of the mitral valve annulus prior toimplanting of the plurality of anchors.

In some embodiments, the apparatus further comprises a balloonconfigured for delivery in a deflated state via the catheter, andconfigured for inflation while at least part of the balloon ispositioned the left ventricle, and wherein the catheter is configured topull the balloon towards the mitral valve annulus prior to implanting ofthe plurality of anchors.

In some embodiments, the apparatus further comprises a balloonconfigured for delivery in a deflated state via the catheter, whereinwhen the balloon is inflated, the balloon guides the tissue engagingmember into position for implantation into the mitral valve annulus.

In accordance with embodiments of another aspect of the invention thereis provided a method for performing a procedure on a heart valveannulus, the heart valve annulus having an original shape. The methodcomprises the steps of: delivering a loop of wire to the vicinity ofheart valve annulus so that the loop of wire conforms with at least aportion of the original shape; delivering a plurality of anchors to thevicinity of heart valve annulus, each of the plurality of anchors havinga pointy front end and a back end, each of the plurality of anchorshaving a slot that runs in a front-to-back direction, wherein the frontends of the plurality of anchors are configured for implantation intoheart valve annulus tissue in a forward direction and wherein theplurality of anchors are configured so that subsequent to implantation,the plurality of anchors resist extraction from the heart valve annulustissue in a backwards direction, wherein the plurality of anchors aredistributed about the loop of wire with the front ends of the pluralityof anchors facing the heart valve annulus and with the loop of wirepassing through the slots in the plurality of anchors; and implantingthe plurality of anchors into the heart valve annulus.

In some embodiments, the loop of wire comprises a closed loop. In someembodiments, the at least a portion of the original shape comprises atleast a 270° portion of the original shape. In some embodiments, each ofthe plurality of anchors the slot begins near the front end of theanchor and ends near the back end of the anchor, and wherein, during theimplanting step, forward motion of the plurality of anchors is limitedwhen the ends of the slots encounter the loop of wire.

In some embodiments, the method further comprises the step of deliveringa plurality of tubes to the vicinity of heart valve annulus, wherein theplurality of tubes are threaded onto the loop of wire between theplurality of anchors and wherein an outer surface of the tubes comprisesa material that promotes tissue growth.

In some embodiments, the method further comprises the step of deliveringa second loop of wire to the vicinity of heart valve annulus that isthreaded through the inside the plurality of tubes, wherein the secondloop of wire comprises a closed loop. In some embodiments, the pluralityof anchors comprises at least six anchors.

In some embodiments, the implanting step comprises driving the pluralityof anchors into the heart valve annulus using a plurality of springs. Insome embodiments, the implanting step comprises driving the plurality ofanchors into the heart valve annulus using a plurality of pull wires. Insome embodiments, the heart valve annulus is a mitral valve annulus, andthe method further comprises the step of pressing the plurality ofanchors towards an upper surface of the mitral valve annulus, whereinthe pressing step is implemented prior to the implanting step andsubsequent to the steps of delivering the loop of wire and deliveringthe plurality of anchors.

In some embodiments, the method further comprises the step of pulling aninflated balloon that is disposed at least partially in a left ventricletowards the mitral valve annulus, wherein the pulling step and thepressing step are performed simultaneously. In some embodiments, themethod further comprises the step of inflating a balloon to guide theanchors into position for implantation into the mitral valve annulus.

In accordance with embodiments of another aspect of the invention thereis provided an apparatus for performing a procedure on a mitral valve,the apparatus comprising: a tissue engaging member including a loop ofwire configured to contact leaflets of the mitral valve when the loop ofwire is deployed, wherein the loop of wire comprises a closed loop, anda plurality of anchors, each of the plurality of anchors having a pointyfront end and a back end, each of the plurality of anchors having a slotthat runs in a front-to-back direction, wherein the front ends of theplurality of anchors are configured for implantation into the leafletsin a forward direction and wherein the plurality of anchors areconfigured so that subsequent to implantation, the plurality of anchorsresist extraction from the leaflets in a backwards direction, whereinthe plurality of anchors are arranged with respect to the loop of wireso that when the loop of wire is deployed the plurality of anchors aredistributed about the loop of wire with the front ends of the pluralityof anchors facing the leaflets and with the loop of wire passing throughthe slots in the plurality of anchors. The apparatus further includesmeans for implanting the plurality of anchors into the leaflets so thatthe tissue engaging member becomes affixed to the leaflets.

In some embodiments, each of the plurality of anchors includes a barbthat, subsequent to implantation, resists extraction from the leafletsin a backwards direction. In some embodiments, each of the plurality ofanchors the slot begins near the front end of the anchor and ends abouthalfway between the front end of the anchor and the back end of theanchor, and during implantation, forward motion of the plurality ofanchors is limited when the ends of the slots encounter the loop ofwire.

In some embodiments, the plurality of anchors comprises at least sixanchors. In some embodiments, the means for implanting comprises aplurality of compressed springs configured to, respectively, implant theplurality of anchors into the leaflets so that the tissue engagingmember becomes affixed to the leaflets.

In some embodiments, the means for implanting comprises a plurality ofpull wires configured to, respectively, implant the plurality of anchorsinto the leaflets so that the tissue engaging member becomes affixed tothe leaflets.

In some embodiments, the apparatus further comprises a catheter having adistal end; and a scaffold comprising a plurality of support armsconfigured to support the plurality of anchors in position adjacent tothe leaflets in a position at which the means for implanting can implantthe plurality of anchors into the leaflets.

In some embodiments, the apparatus further comprises: a catheter havinga distal end; and a scaffold comprising a plurality of support arms,wherein the scaffold is configured for deployment when the distal end ofthe catheter is positioned in the left ventricle and the scaffold isfurther configured to support the plurality of anchors in positionadjacent to the leaflets in a position at which the means for implantingcan implant the plurality of anchors into the leaflets, wherein thecatheter is configured to push the plurality of anchors towards theleaflets prior to implanting of the plurality of anchors.

In some embodiments, the apparatus further comprises: a catheter havinga distal end; and a scaffold comprising a plurality of support arms,wherein the scaffold is configured for deployment when the distal end ofthe catheter is positioned in the left ventricle and the scaffold isfurther configured to support the plurality of anchors in positionadjacent to the leaflets in a position at which the means for implantingcan implant the plurality of anchors into the leaflets, wherein thecatheter is configured to pull the plurality of anchors towards theleaflets prior to implanting of the plurality of anchors.

In accordance with embodiments of another aspect of the invention thereis provided a method for performing a procedure on a mitral valvecomprising the steps of: delivering a loop of wire to a vicinity ofleaflets of the mitral valve, wherein the loop of wire comprises aclosed loop; delivering a plurality of anchors to the vicinity of theleaflets, each of the plurality of anchors having a pointy front end anda back end, each of the plurality of anchors having a slot that runs ina front-to-back direction, wherein the front ends of the plurality ofanchors are configured for implantation into the leaflets in a forwarddirection and wherein the plurality of anchors are configured so thatsubsequent to implantation, the plurality of anchors resist extractionfrom the leaflets in a backwards direction, wherein the plurality ofanchors are distributed about the loop of wire with the front ends ofthe plurality of anchors facing the leaflets and with the loop of wirepassing through the slots in the plurality of anchors; and implantingthe plurality of anchors into the leaflets.

In some embodiments, each of the plurality of anchors the slot beginsnear the front end of the anchor and ends about halfway between thefront end of the anchor and the back end of the anchor, and wherein,during the implanting step, forward motion of the plurality of anchorsis limited when the ends of the slots encounter the loop of wire.

In some embodiments, the plurality of anchors comprises at least sixanchors. In some embodiments, the implanting step comprises driving theplurality of anchors into the leaflets using a plurality of springs. Insome embodiments, the implanting step comprises driving the plurality ofanchors into the leaflets using a plurality of pull wires.

In some embodiments, the method further comprises the step of pressingthe plurality of anchors towards the leaflets, wherein the pressing stepis implemented prior to the implanting step and subsequent to the stepsof delivering the loop of wire and delivering the plurality of anchors.

In accordance with embodiments of another aspect of the invention thereis provided an apparatus for cinching a heart valve annulus, the heartvalve annulus having an original shape, the apparatus comprising: atissue engaging member including a first loop of wire configured toconform with at least a portion of the original shape when the firstloop of wire is deployed, a plurality of anchors, each of the pluralityof anchors having a pointy front end and a back end, each of theplurality of anchors having a slot that runs in a front-to-backdirection, wherein the front ends of the plurality of anchors areconfigured for implantation into heart valve annulus tissue in a forwarddirection and wherein the plurality of anchors are configured so thatsubsequent to implantation, the plurality of anchors resist extractionfrom the heart valve annulus tissue in a backwards direction, whereinthe plurality of anchors are arranged with respect to the first loop ofwire so that when the first loop of wire is deployed the plurality ofanchors are distributed about the first loop of wire with the front endsof the plurality of anchors facing the heart valve annulus and with thefirst loop of wire passing through the slots in the plurality ofanchors, a plurality of tubes threaded onto the first loop of wirebetween the plurality of anchors, wherein an outer surface of the tubescomprises a material that promotes tissue growth, and a second loop ofwire that is threaded through the inside the plurality of tubes, thesecond loop of wire having two ends that are configured so that when thetissue engaging member is affixed to the heart valve annulus, pullingthe two ends will cinch the heart valve annulus; and means forimplanting the plurality of anchors into the heart valve annulus tissueso that the tissue engaging member becomes affixed to the heart valveannulus.

In some embodiments, at least a portion of the second loop of wire issurrounded by a material that inhibits tissue growth. In someembodiments, the at least a portion of the original shape comprises atleast a 270° portion of the original shape. In some embodiments, whereineach of the plurality of anchors includes a barb that, subsequent toimplantation, resists extraction from the heart valve annulus tissue ina backwards direction. In some embodiments, in each of the plurality ofanchors the back end of the slot is enlarged to form an eyelet. In someembodiments, each of the plurality of anchors the slot begins near thefront end of the anchor and ends near the back end of the anchor, andwherein, during implantation, forward motion of the plurality of anchorsis limited when the ends of the slots encounter the first loop of wire.

In some embodiments, the plurality of anchors comprises at least sixanchors. In some embodiments, the means for implanting comprises aplurality of compressed springs configured to, respectively, implant theplurality of anchors into the heart valve annulus tissue so that thetissue engaging member becomes affixed to the heart valve annulus. Insome embodiments, the means for implanting comprises a plurality of pullwires configured to, respectively, implant the plurality of anchors intothe heart valve annulus tissue so that the tissue engaging memberbecomes affixed to the heart valve annulus.

In some embodiments, each of the plurality of anchors includes a barbthat, subsequent to implantation, resists extraction from the heartvalve annulus tissue in a backwards direction, wherein the plurality ofanchors comprises at least six anchors, and wherein the means forimplanting comprises a plurality of compressed springs configured to,respectively, implant the plurality of anchors into the heart valveannulus tissue so that the tissue engaging member becomes affixed to theheart valve annulus. In some embodiments, each of the plurality ofanchors includes a barb that, subsequent to implantation, resistsextraction from the heart valve annulus tissue in a backwards direction,wherein the plurality of anchors comprises at least six anchors, andwherein the means for implanting comprises a plurality of pull wiresconfigured to, respectively, implant the plurality of anchors into theheart valve annulus tissue so that the tissue engaging member becomesaffixed to the heart valve annulus.

In some embodiments, the apparatus further comprises: a catheter havinga distal end; and a scaffold comprising a plurality of support armsconfigured to support the plurality of anchors in position adjacent tothe heart valve annulus in a position at which the means for implantingcan implant the plurality of anchors into the heart valve annulustissue.

In some embodiments, the heart valve annulus is a mitral valve annulus,and the apparatus further comprises: a catheter having a distal end; anda scaffold comprising a plurality of support arms, wherein the scaffoldis configured for deployment when the distal end of the catheter ispositioned in the left atrium and the scaffold is further configured tosupport the plurality of anchors in position adjacent to the uppersurface of the mitral valve annulus in a position at which the means forimplanting can implant the plurality of anchors into the mitral valveannulus, wherein the catheter is configured to push the plurality ofanchors towards the upper surface of the mitral valve annulus prior toimplanting of the plurality of anchors.

In some embodiments, the apparatus further comprises a balloonconfigured for delivery in a deflated state via the catheter, andconfigured for inflation while at least part of the balloon ispositioned the left ventricle, and wherein the catheter is configured topull the balloon towards the mitral valve annulus prior to implanting ofthe plurality of anchors.

In some embodiments, the apparatus further comprises a balloonconfigured for delivery in a deflated state via the catheter, whereinwhen the balloon is inflated, the balloon guides the tissue engagingmember into position for implantation into the mitral valve annulus.

In accordance with embodiments of another aspect of the invention thereis provided a method for cinching a heart valve annulus, the heart valveannulus having an original shape. The method comprising the steps of:delivering a first loop of wire to the vicinity of heart valve annulusso that the first loop of wire conforms with at least a portion of theoriginal shape; delivering a plurality of anchors to the vicinity ofheart valve annulus, each of the plurality of anchors having a pointyfront end and a back end, each of the plurality of anchors having a slotthat runs in a front-to-back direction, wherein the front ends of theplurality of anchors are configured for implantation into heart valveannulus tissue in a forward direction and wherein the plurality ofanchors are configured so that subsequent to implantation, the pluralityof anchors resist extraction from the heart valve annulus tissue in abackwards direction, wherein the plurality of anchors are distributedabout the first loop of wire with the front ends of the plurality ofanchors facing the heart valve annulus and with the first loop of wirepassing through the slots in the plurality of anchors; delivering aplurality of tubes to the vicinity of heart valve annulus, wherein theplurality of tubes are threaded onto the first loop of wire between theplurality of anchors and wherein an outer surface of the tubes comprisesa material that promotes tissue growth; delivering a second loop of wireto the vicinity of heart valve annulus, wherein the second loop of wireis threaded through the inside the plurality of tubes and has a firstend and a second end; implanting the plurality of anchors into the heartvalve annulus; and cinching the second loop of wire by pulling on thefirst end and the second end.

In some embodiments, the at least a portion of the original shapecomprises at least a 270° portion of the original shape. In someembodiments, in each of the plurality of anchors the slot begins nearthe front end of the anchor and ends near the back end of the anchor,and wherein, during the implanting step, forward motion of the pluralityof anchors is limited when the ends of the slots encounter the firstloop of wire. In some embodiments, the plurality of anchors comprises atleast six anchors.

In some embodiments, the implanting step comprises driving the pluralityof anchors into the heart valve annulus using a plurality of springs. Insome embodiments, the implanting step comprises driving the plurality ofanchors into the heart valve annulus using a plurality of pull wires.

In some embodiments, the heart valve annulus is a mitral valve annulus,and the method further comprises the step of pressing the plurality ofanchors towards an upper surface of the mitral valve annulus, whereinthe pressing step is implemented prior to the implanting step andsubsequent to the steps of delivering the first loop of wire anddelivering the plurality of anchors.

In some embodiments, the method further comprising the step of pullingan inflated balloon that is disposed at least partially in a leftventricle towards the mitral valve annulus, wherein the pulling step andthe pressing step are performed simultaneously.

In some embodiments, the method further comprises the step of inflatinga balloon to guide the anchors into position for implantation into themitral valve annulus.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be understood and appreciated more fully fromthe following detailed description taken in conjunction with theappended drawings in which:

FIG. 1 is a front partial cut-away view of an embodiment of a heartvalve repair device of the present invention;

FIG. 2 is an enlarged perspective view of the device of FIG. 1;

FIG. 3 is a perspective view of an implant or tissue engaging member ofthe present device;

FIGS. 4-6 are perspective views of an anchor launching mechanism of thedevice of FIG. 1;

FIGS. 7 and 7 a are perspective views of anchors of the present device;

FIGS. 8-10 are perspective views of an another embodiment of the tissueengaging member;

FIGS. 11 and 12 are perspective views of an exemplary delivery systemfor the present device;

FIG. 13 is a front partially cut-away view of a heart with the implantaffixed to a mitral valve from above the valve;

FIG. 14 is a perspective view of a cinching mechanism of the device;

FIGS. 15-17 are perspective views of additional embodiments of anchors;

FIGS. 18 and 19 are perspective views of embodiments of anchor launchingmechanisms;

FIGS. 20-22 are front partially cut-away views of a heart with theimplant affixed to a mitral valve from below the valve;

FIGS. 23-27 and 27 a are perspective views of further embodiments ofanchor launching mechanisms;

FIGS. 29-34 are perspective views of implant deployment mechanisms;

FIGS. 35-39 are perspective views illustrating the device in use inconjunction with an implantable device;

FIG. 40 is a perspective partially cut-away view of the heart with theimplant deployed for use on a tricuspid valve;

FIG. 41 is a perspective partially cut-away view of the heart with theimplant deployed via the left atrium wall;

FIG. 42 is a view illustrating manual cinching of the device aftertissue healing; and

FIG. 43 is a perspective partially cut-away view of the heartillustrating mechanical cinching of the device after tissue healing.

The following detailed description of embodiments of the inventionrefers to the accompanying drawings referred to above. Dimensions ofcomponents and features shown in the figures are chosen for convenienceor clarity of presentation and are not necessarily shown to scale.Wherever possible, the same reference numbers will be used throughoutthe drawings and the following description to refer to the same and likeparts.

DESCRIPTION OF EMBODIMENTS OF THE INVENTION

A heart valve repair device comprising an implant and delivery system isdelivered into the heart in four sequential stages: In the first stagethe implant and support scaffold are advanced in a collapsedconfiguration inside a capsule through the vascular system to the valveannulus (preferably the Mitral annulus but can be also the Tricuspidannulus). In the second stage after positioning the capsule close to theannulus a support scaffold is pushed outside of the capsule and theimplant which is attached to the scaffold is spread into a round or Dshape circumferential ring onto the valve annulus in 3 optional ways:

1) On the inflow side of the valve with attachment anchors pointing fromthe atrium side to the ventricle side;

2) On the inflow side of the valve with attachment anchors pointing fromthe ventricle side to the atrium side; and

3) On the outflow side of the valve with attachment anchors pointingfrom the ventricle side to the atrium side.

In the third stage after the implant is spread out, all the anchors arelaunched into the tissue at once or in a sequential manner and affix theimplant to the tissue. The same action also separates the implant fromthe support scaffold and delivery system. In the fourth stage thescaffold is retracted and collapsed back into the delivery capsule andthe delivery system is withdrawn out of the body.

It is important to note that in some embodiments the spread implantconforms at least partially to the valve annulus shape, and in someembodiments the spread implant does not conform at all to the valveannulus shape, but is just affixed to the valve leaflets and is retainedthere for a few minutes until a valve prosthesis is deployed into it aswill be described later on.

After the implant is attached to the valve tissue it is possible totreat the valve insufficiency in 5 optional ways:

1) By direct annuloplasty which impose cinching of the implant attachedto the valve annulus, hence reducing the annulus diameter and improvingvalve leaflets coaptation;

2) By restricting annulus dilatation over time due to the constantperimeter of the implant which is attached to the valve annulus and getsembedded into the tissue over time through tissue growth;

3) By facilitating a support ring for valve prosthesis to be implantedat a later procedure after the implant which is attached to the valveannulus gets embedded into the tissue over time through tissue growth;

4) By performing annuloplasty at a later stage in a different procedureweeks or months later after the implant which is attached to the valveannulus gets embedded into the tissue over time through tissue growth;and

5) By facilitating a support ring for valve prosthesis that can beimplanted into the ring during the same procedure right after the ringis attached to the valve leaflets.

Illustrative embodiments of the invention are described below. In theinterest of clarity, not all features/components of an actualimplementation are necessarily described.

FIG. 1 shows an embodiment of a mitral valve adjustment/repair implant10 of the present invention, implanted onto a bio-valve, exemplified bymitral valve M of the heart. Implant 10 comprises: a tissue engagingmember 12, comprising a loop 14 of wire and a plurality of tissueanchors 16 associated with the loop and having and an elongated slot 17(FIG. 5); a scaffold or implant positioning device 18, in thisembodiment comprising plurality of support arms 20; and an anchorlaunching mechanism 22 (FIGS. 2-7). Implant 10 is typically positionedin proximity of the mitral valve M via a delivery catheter C. The loop14 of wire is preferably made of metal wire, but in alternativeembodiments the wire may be a non-metallic material. Note that as usedherein, “wire” includes metal and/or non-metallic materials.

FIG. 2 shows an enlarged view of the device in FIG. 1 illustratinganchor launching mechanism 22 in a ready for deployment (launching) anddeployed state, respectively; Elongated slot 17 of anchors 16 allow loop14 to be retained by (operably attached to) the anchors—which will beexplained further herein below. FIG. 3 shows an embodiment of implant 10in its configuration when implanted, as will be discussed further below.

FIGS. 4-6 show details of anchor launching mechanism 22, which comprisesa housing 24, typically cylindrical; an anchor launching biasingmechanism, such as coil spring 26 disposed within the housing; and aspring actuator wire 28, having a bent distal end 29, passing throughelongated slot 17 and protruding through a window 30 of housing 24. Bentdistal end 29 maintains spring 26 is a compressed configuration.Actuator wire 28 passes longitudinally/coaxially through coil spring 26.Implant support arms 20 are respectively attached to housings 24, forexample by welding. It should be noted that actuator wire 28 can be madeof any appropriate material and is not limited to metal.

Housing 24 has an open end 32 and a spring retention end 34, which insome embodiments comprises a crimped portion 36 or other such springretention mechanism, to provide a launching base for spring 26. In someembodiments, to prevent spring 26 from being ejected from (falling outof) housing 24, spring has a hooked proximal end 38 adapted to hook atretention end 34 of the housing. As can be seen, loop 14 is threadedthrough each elongated slot 17 of tissue anchors 16. As best seen inFIG. 4, in some embodiments, housing 24 has a pair of elongated recesses40 at open end 32 whereby loop 14 can pass. FIGS. 4 and 5 show anchors16 in a pre-launch state where spring 26 is compressed, and FIG. 6 showsthe anchors in a launched state with the spring in its normally expandedconfiguration.

As shown, tissue anchors 16 are typically spaced apart all along loop 14and loop 14 is threaded through elongated slot 17, allowing the tissueanchor to move (be launched), typically more or less perpendicular(although in some embodiments at an angle) with respect to the loop. Itshould be noted that loop 14 can be made of any appropriate material andis not limited to metal. Note that while eight anchors are depicted inall the illustrated embodiments, the number of anchors can be varied.Preferably at least six anchors are used.

With reference to FIG. 7, in some embodiments, each anchor 16 has aproximal portion 42 including a spring interfacing portion exemplifiedby a pair of flat shoulders 44. Anchors 16 also have a pointy front end46, typically with one or more barbs 48. After an anchor is implanted inthe forward direction, the barbs 48 resist extraction of the anchor 16in a backwards direction. In some embodiments, elongated slot 17 has arelatively large or bulbous open portion or eyelet 50 adjacent proximalportion 42, which can be useful to provide additional space for bentdistal end 29 to pass through the elongated slot along with loop 14.

FIGS. 8-10 shows a modification of the implant wherein loop 14 has aplurality of tissue growth-promotion tubes 52 coaxially surrounding theloop between anchor positions. In some embodiments, tissuegrowth-promotion tubes 52 have respective tissue growth inhibitingliners or surfaces 54 (FIG. 10). Tissue growth-promotion tubes 52 aremade of a material and/or substance adapted to promote and facilitatethe growth of tissue thereon, for example an appropriate fabric orcoating. If indeed in the form of liners, tissue growth inhibitingliners 54 are disposed tissue growth-promotion tubes 52, e.g. coaxially,and include tissue growth inhibiting material/substance.

FIGS. 9 and 10 additionally show another embodiment wherein there aretwo loops, the aforementioned loop 14 and a relatively sturdy auxiliaryloop 56 to provide additional robustness to the implant if so desired.FIG. 10 shows a modification wherein auxiliary loop further includes aproximal portion 58 that can be used to position the implant 10, inaddition to or in place of the above mentioned implant positioningdevice 18.

Operation: implant 10 is deployed to a position adjacent the bio-valve(e.g. Mitral valve M) via/through delivery catheter C (see FIGS. 11 and12; and also FIGS. 1 and 2). When implant 10 is appropriately located,using support arms 20 and\or auxiliary loop 56 with its proximal portion58, actuator wire 28 of each anchor launching mechanism 22 is retractedthereby withdrawing their bent distal ends 29 from respective windows 30of housings 24. As a result, springs 26 are released from theircompressed state to their expanded state thereby launching tissueanchors 16 into the bio-valve tissue. Typically, pointy end 46 of eachanchor 16 enters the tissue, and barbs 48 help to prevent inadvertentdetachment of the anchors.

FIG. 13 illustrates implant 10 connected to the tissue of mitral valve Mof the heart after the launching of tissue anchors 16 into the tissue.Implant 10 is positioned on the top of the mitral valve M, as a resultof being inserted into the heart in a manner such as shown in FIG. 1,and anchors 16 face generally downward. After the implantation naturaltissue growth start to occur all around the parts of implant 10 that arewithin the tissue notably the anchors, and later on tissue growth willcover also parts of the implant at close proximity to the tissuesurface. When tissue growth fills the anchors slot 17 they becomemechanically locked within the tissue, and over time the entire implant10 will get embedded in the valve annulus tissue. Since the implant islargely comprised of loop 14 which is made of non elastic substance,further annulus dilatation over time due to progression of the valveregurgitation disease is prevented.

With reference to FIG. 14, in some embodiments, the implant furthercomprises a cinching mechanism 60, for example wherein loop 14 is not ina closed loop configuration rather has generally adjacent free ends 62and 64. The ring-like portion of loop 14 passes through elongated slots17 of anchors 16 (and in suitable embodiments, through tissuegrowth-promotion tubes 52), as before. After sufficient tissue grows onimplant 10, which typically takes one week to several months, dependingon the tissue growth rate, the implant may be cinched via pulling on oneor both of the free ends 62 and/or 64 to reduce the diameter of tissueengaging member 12, (however, in some implementations of the operation,cinching action is not required, and could be excluded from procedure).Free ends 62 and 64 may extend outside the patient's body or remainunder the skin at the upper portion of the chest, much like pace makerleads. The tissue growth causes implant 10 to be embedded and integratedto the valve annulus. In addition, tissue growth within elongated slot17 helps secure anchors 16 and prevents the implant from being dislodgedfrom the valve annulus.

FIG. 14 further illustrates a D-shaped loop 14, in contrast to thecircular or oval shaped loops illustrated in the aforementioned figures.D-shaped loop 14 is particularly suited for use with a human mitralheart valve. In this regard, it should be understood that loop 14 can beconfigured by choice or design to appropriately correspond to theparticular bio-valve for which repair is required.

FIG. 15 shows another embodiment wherein instead of anchors 16 engagingloop 14 via elongated slot 17, the anchors pass thru a coaxial tube 66coaxially surrounding the loop—the tube could be, for example a tissuegrowth promotion tube such as tissue growth-promotion tubes 52.Retention of anchors 16 with coaxial tube 66 is aided by a retentionhook 68 at the proximal end of the anchors.

FIGS. 16 and 17 depict an embodiment where anchor 16 has a cylindricalshape, similar to housing 24 and no such housing is required. In thiscase spring 26 is held in compression between end 34 of cylindricalanchor 16 and a spring launching base, exemplified by a launching basering 70, attached to implant support arms 20. End 34 now provides thefunction of the aforementioned flat shoulders 44; and launching basering provides the function of the aforementioned crimped portion 36.When actuator wire 28 is retracted, its bent distal end 29 (here,illustrated in the form of a half-loop) is retracted from window 30thereby releasing cylindrical anchor 16 so that spring 26 expands tolaunch the anchor.

FIGS. 18 and 19 shows implant positioning device 18 configured, mutatismutandis, wherein anchor launching mechanism 22 is adapted to launchanchors 16 into the tissue in a generally upward direction (i.e. fromthe ventricle side to the atrium side). This embodiment is particularlyuseful in the case where the tissue engaging member 12 serves as asupport to prevent dislodgement of a valve prosthesis that can beexpanded into it right after the tissue engaging member 12 has beendeployed.

FIGS. 20-24 illustrate embodiments adapted for situations wherelaunching anchors 16 upwardly may also be used in cases where access tothe insufficient valve is from below, for example via the Apex (see FIG.20), is preferable rather than from above. FIGS. 20 and 22 show loop 14disposed under the Mitral valve leaflets and FIG. 21 shows loop 14disposed onto the Mitral valve leaflets M as the anchors 16 penetratesthrough the leaflets pointing from the ventricle side to the atriumside.

FIGS. 23 and 24 show the pre-launch and launch situations for upwardlaunching of anchors 16. FIG. 23 further illustrates that catheter C canbe used to help orient the angle of housings 24, and thus the launchangle of anchors 16. If the distance between catheter C and loop 14 isrelatively small, anchors 16 tends to be positioned and launched at agreater angle (relative to being launched perpendicular to loop 14, aswas shown in FIGS. 2 and 3, for example). Adjustment of the launchangle, i.e. pivoting of anchors angle, is made possible by the shape ofthe support arms 20 to which the housing 24 is attached. FIG. 24 alsoillustrates another modification wherein anchors 16 comprise multiplebarbs 48 and wherein elongated slot 17 extends about half-way within thelength of the anchors.

FIGS. 25-27 and 27 a illustrate particular embodiments wherein anchorlaunching mechanism 22 is adapted to be used with tissue anchors 16 thatare launched in a generally upward direction; and can be actuated by adirect pull, or by a mechanism removed from the valve area. Anchorlaunching mechanism 22 comprises actuation wire 28 and housing 24,however the mechanism does not include spring 26 disposed in thehousing. Regardless, for rapid actuation purposes (anchor launch),anchor launch mechanism 22 may further include an external launchactuator device, typically including a spring (not shown), for example,at the proximal end of catheter C, to pull on actuation wire 28. Whenthe catheter approaches from the inflow side of the valve, and routesthe anchors so that they are below the valve with the tip directed fromthe ventricle side to the atrium side, this configuration and approachto the valve permits pull wires to be used.

For the purposes of these embodiments, anchor 16 may be modified tofurther comprise an actuation wire eyelet 72 where-through actuationwire 28. Distal end 29 of actuation wire 28 is threaded through eyelet72 and typically has a hook-like configuration while disposed withinhousing 24 (FIGS. 25 and 27). Pulling on actuator wire 28 proximal endto pull (launch) anchor 16 as a result of pulling at eyelet 72 (FIG.26). In such embodiments, housing 24 need not include a window such aswindow 30, nor does not need a crimped portion 36 or other such springretention mechanism, as there is no spring in the housing. FIGS. 27 and27 a illustrates a modification wherein instead of eyelet 72; eachanchor 16 has a actuator-wire distal-end receiving portion such asrecess 74, which operates to launch anchors 16 in the same fashion asnoted above.

FIGS. 28-30 show embodiments, wherein implant 10 further comprises aloop-arrangement/anchor-orientation mechanism 76 useful for arrangingthe position and/or shape of loop 14 and/or for orienting the angle ofhousings 24, and thereby orienting the launch angle of tissue anchors16. Anchor orientation mechanism 76 includes a plurality of curvedarrangement leads 78 respectively attached to at least some of housings24, for example by welding. Leads 78 may be an extension of implantsupport arms 20 and may be arranged to cross at a singular intersectionpoint 80. Leads 78 are attached (e.g. by welding) to housing 24. Thus,leads 78 of orientate mechanism 76 are movable to arrange loop 14 in adesired location and depending on the shape of the leads, the angle ofhousings 24, and thus anchors 16, can be determined.

Regarding the launch angle of anchors 16, in some embodiments, leads 78can be attached “ad hoc” prior to insertion into a patient, whereby,depending on the attachment location, arrangement leads 78 also be usedto orient anchors 16 i.e. control the angle at which the anchors enterthe tissue (i.e. changing the length or shape of one or more leads 78will thus change the angle of the anchors, e.g. shortening the thatlength will cause the anchors to point outward, whereas increasing thatlength will bring intersection point 80 farther from loop 14 and thusangle the anchors more parallel to each other (less outward). In suchcase, leads 78 will not be welded to housings 24, rather there will beincluded an “ad hoc” connection or fastening arrangement (not shown),whereby the leads and housings are connected at more than one locationalong the leads. Arrangement/orientation mechanism 76 can be useful forarranging the shape of loop 14 as well as positioning the loop andorienting the anchor angle. In alternative embodiments,loop-arrangement/anchor-orientation mechanism 76 either has apredetermined shape, such as a nipple shape (FIGS. 29 and 30) or isadapted to allow its shape to be changed; i.e. leads 78 can be bent.

FIGS. 31-34 show embodiments wherein loop arrangement and/or implantpositioning device 18 comprises an inflatable balloon 82. The figuresshow exemplary balloons 82 useful for a) making sure support arms 20 arefully expanded before deploying implant 10, b) make sure that loop 14 isconcentric with the valve annulus prior to implantation, and c)facilitating an interference step or backing against which to press tobe used for pressing implant positioning device 18 and implant 10 ontothe valve annulus before implantation as illustrated in FIG. 34. FIG. 31illustrates an oval balloon 82; FIGS. 32-34 illustrate a droplet-shapedor bulbous balloon 82.

As seen in FIG. 34, as well as being useful to orient loop 14 relativeto the valve annulus, the balloon can be used to secure the implantpositioning device 18 and implant 10 in place during launching ofanchors 16. FIGS. 32 and 33 also illustrate that balloon 82 can bepositioned proximally or distally with respect to loop 14 and implantpositioning device 18. Since the balloon can be positioned inside theventricle and be inflated to a diameter bigger than the diameter ofbiological valve annulus, it can serve as a backing against which topress positioning device 18 and implant 10 onto the valve annulus beforeimplantation. This will ensure good contact between each of the anchorlaunching mechanisms 22 and the valve annulus and will create optimalpenetration conditions of anchor 16 into the tissue upon launching.Furthermore, the launch angle of anchors 16 (i.e. insertion into thetissue) can be controlled by inflating/deflating balloon 82, withconsideration to the size of the biological valve.

FIGS. 35-37 illustrate how a device 100 (e.g., a replacement valve) canbe fixed to a native valve annulus or leaflets like the mitral valve Mor tricuspid valve. In this embodiment, implant 10 is first implantedand secured with anchors 16 that penetrate the valve leaflets pointingfrom the ventricle V side toward the atrium A side (hereinafter upwards)as in FIG. 21 and/or FIG. 22. Then, when device 100 is expanded intoimplant 10, the friction between anchors 16 and the device 100 securesdevice 100 in place. Since anchors 16 are directed generally upward, thehigh pressure in ventricle V helps to further enhance the anchoring ofimplant 10 to the valve leaflets.

Device 100 in the illustrating figures represents any suitablecommercial expandable heart valve prosthesis that can be tracked in acollapsed configuration through the vascular system and delivered to theheart. It can be a self expanding prosthesis or a balloon expandingprosthesis or any other type of expanding heart valve prosthesis. FIG.35 further illustrates an exemplary delivery system 101 that can deliverdevice 100 to the heart.

FIGS. 36 and 37 illustrate how implant 10 can be associated with device100 for fixing the device to a mitral valve M (or tricuspid valve)leaflets. In this embodiment, implant 10 and device 100 are implantedvia the heart's apex P, preferably, in a minimally invasive surgery asillustrated in FIG. 20. As in FIG. 22, implant 10 is first located atthe proper location with respect to the bio-valve (mitral in this case)and then secured with anchors 16 facing upward, in accordance with anyappropriate embodiment as described herein. After implant 10 is attachedto the valve leaflets, device 100 is advanced, as shown in FIG. 36through a delivery catheter (not shown), and expanded into implant 10 asseen in FIG. 37. Since anchors 16 are directed generally upward, thehigh pressure in the ventricle V helps to further enhance the anchoringof the implant 10 and device 100 to the valve leaflets. However, for thepurpose of this embodiment, wherein implant 10 is configured to beparticularly suited to securing a device in place such as device 100,each anchor 16 has a relatively shorter slot 17, typically extendingonly about half-way along the longitudinal dimension of each anchor,from about half-way along the anchor to relatively close to the anchors'pointy front end 46.

With reference to FIGS. 38 and 39, when device 100 is disposed in theappropriate heart (or other biological) valve and expanded, the contactand sliding motion between the device and anchor 16 changes the angle ofthe anchors from typically approximately 45 degrees (FIG. 38), although,depending on the angle of support arms 20, to an angle wherein theanchors are more parallel to each other, typically substantiallyparallel. The movement of anchors 16 is illustrated by arc A-B in FIG.38. In other words, anchors 16 pivots at the end of slot 17, as in FIG.7 a which is generally at mid-point 84 of the anchors. This angle changeprovides increased friction between anchors 16 and device 100 therebysecuring the device in place.

To further explain, device 100 is expanded in the bio-valve until thedevice presses on a non-slotted portion 86 of anchors 16. As a result ofpressing on non-slotted portion 86, that portion is forced outward, andthus the tip of the anchors 46 is moved inward, as the anchors pivotaround loop 14. Since anchor tips 46 are locked within the tissue of thevalve leaflet, the inward motion of the tips pulls the leaflets closerto device 100 and presses the leaflets against the device, therebyenhancing the sealing and prevent blood flow between the native valveleaflet and the device. It should be understood that device 100 isappropriately sized for the above-described positioning.

FIG. 40 illustrates deployment of implant 10 in the tricuspid heartvalve T and it should be understood that all the features and functionsof the implant and delivery system as illustrated in FIGS. 1 to 39 areapplicable to the tricuspid valve.

FIG. 41 illustrates deployment of implant 10 through the left atriumwall rather than tracking in through the vascular system, or deployingthe implant through the apex of the heart. Again, it should beunderstood that all the features and functions of the implant anddelivery system illustrated in FIGS. 1 to 39 are applicable todeployment through the atrium wall.

FIG. 42 illustrates manual cinching of the device in a later procedureafter tissue healing has occurred as described above with reference toFIG. 14.

FIG. 43 illustrates cinching of the device in a later procedure aftertissue healing has occurred as described above with reference to FIG.14. Using a mechanical actuator 110 that is implanted during procedure.The mechanical actuator can be actuated and operated magnetically,electrically or by any other appropriate mechanism from outside of thebody.

It should be understood that the above description is merely exemplaryand that there are various embodiments of the present invention that maybe devised, mutatis mutandis, and that the features described in theabove-described embodiments, and those not described herein, may be usedseparately or in any suitable combination; and the invention can bedevised in accordance with embodiments not necessarily described above.

1. An apparatus for performing a procedure on a heart valve annulus, theheart valve annulus having an original shape, the apparatus comprising:a tissue engaging member including a loop of wire configured to conformwith at least a portion of the original shape when the loop of wire isdeployed, and a plurality of anchors, each of the plurality of anchorshaving a pointy front end and a back end, each of the plurality ofanchors having a slot that runs in a front-to-back direction, whereinthe front ends of the plurality of anchors are configured forimplantation into heart valve annulus tissue in a forward direction andwherein the plurality of anchors are configured so that subsequent toimplantation, the plurality of anchors resist extraction from the heartvalve annulus tissue in a backwards direction, wherein the plurality ofanchors are arranged with respect to the loop of wire so that when theloop of wire is deployed the plurality of anchors are distributed aboutthe loop of wire with the front ends of the plurality of anchors facingthe heart valve annulus and with the loop of wire passing through theslots in the plurality of anchors; and means for implanting theplurality of anchors into the heart valve annulus tissue so that thetissue engaging member becomes affixed to the heart valve annulus. 2.The apparatus of claim 1, wherein the loop of wire comprises a closedloop.
 3. The apparatus of claim 1, wherein the at least a portion of theoriginal shape comprises at least a 270° portion of the original shape.4. The apparatus of claim 1, wherein each of the plurality of anchorsincludes a barb that, subsequent to implantation, resists extractionfrom the heart valve annulus tissue in a backwards direction.
 5. Theapparatus of claim 1, wherein in each of the plurality of anchors theback end of the slot is enlarged to form an eyelet.
 6. The apparatus ofclaim 1, wherein in each of the plurality of anchors the slot beginsnear the front end of the anchor and ends near the back end of theanchor, and wherein, during implantation, forward motion of theplurality of anchors is limited when the ends of the slots encounter theloop of wire.
 7. The apparatus of claim 1, wherein the tissue engagingmember further includes a plurality of tubes threaded onto the loop ofwire between the plurality of anchors, wherein an outer surface of thetubes comprises a material that promotes tissue growth.
 8. The apparatusof claim 7, wherein the tissue engaging member further includes a secondloop of wire that is threaded through the inside the plurality of tubes,and wherein the second loop of wire comprises a closed loop.
 9. Theapparatus of claim 8, wherein at least a portion of the second loop ofwire is surrounded by a material that inhibits tissue growth.
 10. Theapparatus of claim 1, wherein the plurality of anchors comprises atleast six anchors.
 11. The apparatus of claim 1, wherein the means forimplanting comprises a plurality of compressed springs configured to,respectively, implant the plurality of anchors into the heart valveannulus tissue so that the tissue engaging member becomes affixed to theheart valve annulus.
 12. The apparatus of claim 1, wherein the means forimplanting comprises a plurality of pull wires configured to,respectively, implant the plurality of anchors into the heart valveannulus tissue so that the tissue engaging member becomes affixed to theheart valve annulus.
 13. The apparatus of claim 1, wherein the loop ofwire comprises a closed loop, wherein each of the plurality of anchorsincludes a barb that, subsequent to implantation, resists extractionfrom the heart valve annulus tissue in a backwards direction, andwherein the plurality of anchors comprises at least six anchors.
 14. Theapparatus of claim 13, wherein the means for implanting comprises aplurality of compressed springs configured to, respectively, implant theplurality of anchors into the heart valve annulus tissue so that thetissue engaging member becomes affixed to the heart valve annulus. 15.The apparatus of claim 13, wherein the means for implanting comprises aplurality of pull wires configured to, respectively, implant theplurality of anchors into the heart valve annulus tissue so that thetissue engaging member becomes affixed to the heart valve annulus. 16.The apparatus of claim 1, further comprising; a catheter having a distalend; and a scaffold comprising a plurality of support arms configured tosupport the plurality of anchors in position adjacent to the heart valveannulus in a position at which the means for implanting can implant theplurality of anchors into the heart valve annulus tissue.
 17. Theapparatus of claim 1, wherein the heart valve annulus is a mitral valveannulus, and wherein the apparatus further comprises: a catheter havinga distal end; and a scaffold comprising a plurality of support arms,wherein the scaffold is configured for deployment when the distal end ofthe catheter is positioned in the left atrium and the scaffold isfurther configured to support the plurality of anchors in positionadjacent to the upper surface of the mitral valve annulus in a positionat which the means for implanting can implant the plurality of anchorsinto the mitral valve annulus, wherein the catheter is configured topush the plurality of anchors towards the upper surface of the mitralvalve annulus prior to implanting of the plurality of anchors.
 18. Theapparatus of claim 17, further comprising a balloon configured fordelivery in a deflated state via the catheter, and configured forinflation while at least part of the balloon is positioned the leftventricle, and wherein the catheter is configured to pull the balloontowards the mitral valve annulus prior to implanting of the plurality ofanchors.
 19. The apparatus of claim 17, further comprising a balloonconfigured for delivery in a deflated state via the catheter, whereinwhen the balloon is inflated, the balloon guides the tissue engagingmember into position for implantation into the mitral valve annulus. 20.A method for performing a procedure on a heart valve annulus, the heartvalve annulus having an original shape, the method comprising the stepsof: delivering a loop of wire to the vicinity of heart valve annulus sothat the loop of wire conforms with at least a portion of the originalshape; delivering a plurality of anchors to the vicinity of heart valveannulus, each of the plurality of anchors having a pointy front end anda back end, each of the plurality of anchors having a slot that runs ina front-to-back direction, wherein the front ends of the plurality ofanchors are configured for implantation into heart valve annulus tissuein a forward direction and wherein the plurality of anchors areconfigured so that subsequent to implantation, the plurality of anchorsresist extraction from the heart valve annulus tissue in a backwardsdirection, wherein the plurality of anchors are distributed about theloop of wire with the front ends of the plurality of anchors facing theheart valve annulus and with the loop of wire passing through the slotsin the plurality of anchors; and implanting the plurality of anchorsinto the heart valve annulus.
 21. The method of claim 20, wherein theloop of wire comprises a closed loop.
 22. The method of claim 20,wherein the at least a portion of the original shape comprises at leasta 270° portion of the original shape.
 23. The method of claim 20,wherein in each of the plurality of anchors the slot begins near thefront end of the anchor and ends near the back end of the anchor, andwherein, during the implanting step, forward motion of the plurality ofanchors is limited when the ends of the slots encounter the loop ofwire.
 24. The method of claim 20, further comprising the step ofdelivering a plurality of tubes to the vicinity of heart valve annulus,wherein the plurality of tubes are threaded onto the loop of wirebetween the plurality of anchors and wherein an outer surface of thetubes comprises a material that promotes tissue growth.
 25. The methodof claim 24, further comprising the step of delivering a second loop ofwire to the vicinity of heart valve annulus that is threaded through theinside the plurality of tubes, wherein the second loop of wire comprisesa closed loop.
 26. The method of claim 20, wherein the plurality ofanchors comprises at least six anchors.
 27. The method of claim 20,wherein the implanting step comprises driving the plurality of anchorsinto the heart valve annulus using a plurality of springs.
 28. Themethod of claim 20, wherein the implanting step comprises driving theplurality of anchors into the heart valve annulus using a plurality ofpull wires.
 29. The method of claim 20, wherein the heart valve annulusis a mitral valve annulus, and wherein the method further comprises thestep of pressing the plurality of anchors towards an upper surface ofthe mitral valve annulus, wherein the pressing step is implemented priorto the implanting step and subsequent to the steps of delivering theloop of wire and delivering the plurality of anchors.
 30. The method ofclaim 29, further comprising the step of pulling an inflated balloonthat is disposed at least partially in a left ventricle towards themitral valve annulus, wherein the pulling step and the pressing step areperformed simultaneously.
 31. The method of claim 29, further comprisingthe step of inflating a balloon to guide the anchors into position forimplantation into the mitral valve annulus. 32-70. (canceled)